Trends in Firearm-Associated Fractures in Pediatric Patients: A Nationwide Analysis (2012-2019)

Introduction: Firearm-associated injuries (FAIs) are a leading cause of death in children and adolescents in the United States. Among these injuries, fractures are a common comorbidity, leading to significant morbidity and financial burden. This study analyzes the trends in firearm-associated fractures (FAFs) in pediatric populations from 2012 to 2019, focusing on injury demographics, causes, and treatment outcomes.

Methods: We used data from the Kids' Inpatient Database (KID) for the years 2012, 2016, and 2019 to identify pediatric patients aged 0 to 20 years who were admitted with both firearm-related injuries and fractures. Fractures of the extremities, pelvis, and spine were included. Patients were grouped by age into four categories: 0-4, 5-9, 10-14, and 15-20 years. Logistic regression models were used to analyze demographic data, injury mechanisms (assault, unintentional), and hospital outcomes, including length of stay and cost.

Results: From 2012 to 2019, there were 20,500 firearm-associated fractures identified in the database. The 15-20 year age group remained the most affected, accounting for 63% of all cases, while the 0-4 year age group showed a significant rise in injury incidence, particularly in cases of unintentional injury (P < 0.05). The incidence of FAFs increased from 85 per 100,000 admissions in 2012 to 110 per 100,000 in 2019 (P=0.007). Minority groups, especially African American males, were disproportionately affected, with 69% of cases occurring in this demographic. Assault remained the most common cause, but the incidence of unintentional injuries, particularly among young children, increased by 25% over the study period. Hospitalizations for FAFs were associated with longer stays and higher costs, with a mean increase in total hospital charges of 48% from 2012 to 2019 (P < 0.001).

Conclusion : The incidence of firearm-associated fractures in pediatric patients has increased over the years, particularly among young children due to unintentional injuries. Adolescents and minority populations continue to be disproportionately affected. The growing burden of these injuries underscores the need for enhanced prevention strategies, including firearm safety education and community-based interventions to reduce gun violence.